Public Health's Leonard Syme: "Social Epidemiology Is Failing"

Leonard Syme, professor emeritus at the University of California-Berkeley School of Public Health, is something of a bomb thrower when it comes to talking about his field, social epidemiology.

"My field of epidemiology is failing to do the things it was intended to do," he told California Endowment Health Journalism Fellows in Los Angeles on Friday. "The whole field is based on the idea that if we can identify factors that lead to disease, we'll share those with people and they'll rush home to change their behavior. Well, that hasn't worked."

In one large research study he worked on in the 1970s, a control group of men at serious risk of heart disease actually changed their behavior by eating more healthfully and exercising more than did men in the experimental group, who likely felt that health providers would do the work for them.

"The study failed," he said, "We had energized an entire control group by telling they were at risk for kicking the bucket – then kicked them out of the study and told them to work on it with their own doctors. They started eating salad. We gave the intervention group the best care, the best interventions - and they relaxed."

The experience forced Syme to start thinking about larger forces than individual behavior that shape people's health: the environment, access to healthy food, access to health care. He recently embarked on a new, Robert Wood Johnson Foundation-funded project that will examine, and try to mitigate, how those forces affect the health of Las Vegas casino workers who live in one of the city's poorest neighborhoods.

 "If we keep studying the trees, we'll never see the forest," he told the group of journalists. "Our record of success is below zero" in communicating the importance of these issues to the public. "Maybe you guys will do better."